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Threat and Hazard Identification and Risk Assessment

Event Impact Guide

April 2017

This document serves as an annex to the Threat and Hazard Identification and Risk Assessment Guide

2016 Core Capabilities

Commonalities between Hazards

Capability Hazard Health System Preparedness Pandemic Influenza

Medical Facility Evacuation Severe Storm Electrical Power Failure IT Failure (Communications)HurricanesSevere Winter Storm Nor’easter Emerging Infectious Disease

Health System Recovery HurricaneLarge Area Flood Emerging infectious DiseaseNor’easter

Medical Surge

Medical and / or Trauma

Heat Wave Pandemic Influenza Patient Surge Severe Winter Storm Emerging infectious Disease

Responder Health and Safety Medical Facility Evacuation Nor’easter Hurricane

Volunteer Management Pandemic Influenza Medical Facility EvacuationHurricane

EOC Operations All depending on the scope

Information Sharing All depending on the scope

Event Impacts

Threat / Hazard: Medical Facility Evacuation (One or more facilities)

Health System Preparedness, Responder Health and Safety, Volunteer Management Core Capability: Human Impact:

Mortality Minimal Impact – low risk

EMS Operations EMS would be affected, possible overload of the system

ED Visits ED surge at other locations may be affected

Primary Care Office Visits Moderate increase in visits might be seen

Trauma Center Injuries This event should not affect Trauma Centers

Mental Health Impact Long Term Care Could see decline in the mental health of residents who are being evacuated

Hospitals Moderate Impact

Outpatient Services – at hospital NOT AT HOSPITAL (AT ANOTHER SITE, POSSIBLY OFF CAMPUS)

High Impact could be seen

Low impact could be seen

Hospital (House) Bed Availability Impact at receiving facilities

ED Bed Census Could increase at receiving facilities

Community Impact: Water supply

Depends of the event / incident

Would be affected

Public Utilities

Transportation

Business Continuity Community / Facility Resilience

Cancelling of elective surgeries Unable to service ESRD patients Home Healthcare Services availability could decrease

Population Displacement Hazards Slip / Trip / fall injuries increase Low temperature injuries increase

Environmental Considerations Minimal Impact

Public Health Services Impact: Information Sharing There would be an increased need for information sharing

among healthcare partners

Mass Care / Sheltering This could be affected

Mass Prophylaxis / Medical Countermeasure Management

N/A

Fatality Management Minimal impact

At Risk Populations - at risk populations are at greater risk for negative issues from certain disasters than the general population. Hearing Disability

Could affect this population

Vision Disability

Ambulatory Disability

Cognitive Disability

Pediatrics Should not be affected unless involved in the evacuation

Geriatrics Should not be affected unless involved in the evacuation

Scope of Impact

☐ Single Location, Small Area

The regional scope of this incident is minimal, confined to a small area or within a single community. At most, two hospitals would be impacted.

☐ Single Location, Large Area

The regional scope of this incident is confined to a single large area or within a larger community. At most, three hospitals and/or healthcare facilities would be impacted.

☐ Multiple Isolated Locations

Several areas (but not more than one-quarter) of the region are affected by this incident. At least four hospitals and/or healthcare facilities in the region will be impacted in some way.

☐ Half of Region Half of the region is affected by this incident. At least six hospitals and/or healthcare facilities in the region will be impacted in some way.

☐ Most of Region Much of the region is affected by this incident. At least nine hospitals and/or healthcare facilities in the region will be impacted in some way.

☒ Entire Region The vast majority of the region is affected by this incident. All hospitals and/or healthcare facilities in the region, and others in adjacent/nearby regions, will be impacted in some way.

Event Impacts

Threat / Hazard: Severe Storm - (windstorms; thunderstorms; hail; tornados)

Health System preparedness, Health System Recovery Core Capability: Human Impact:

Mortality Minimal impact

EMS Operations Increase in call volumeIssue with gaining access due to impassible roads and downed wires

ED Visits Decrease during the event Increase after the event

Increased staffing issues needed

Primary Care Office Visits Could be affected by this event

Trauma Center Injuries Slight increase 6-12 hours post- storm

Mental Health Impact Could be affected by this event

Outpatient Services Could be affected by this event

Hospital (House) Bed Availability Decrease due to a loss of ability to discharge patients during the storm

ED Bed Census Increase 6-12 hours post storm

Community Impact: Water supply Possibly affected after the storm by contaminants

Public Utilities Wind damage on above ground wires

Transportation Might be affected


Might be affected i.e. Broken Windows

o Amount of time to restore services Population Displacement Moderate impact

Shelter location for general population

Environmental Considerations Possible water contamination

Public Health Services Impact: Information Sharing Increased need for information sharing

Mass Care / Sheltering This event could increase the need for sheltering


N/A

Fatality Management Normal effect; no additional impact

At Risk Populations Hearing Disability

Normal risk needs • Medications • Power (any homecare machines) / heat • Dr. Visits

Vision Disability



Pediatrics This group would be affected

Geriatrics This group would be affected

Scope of Impact







☒ Half of Region Half of the region is affected by this incident. At least six hospitals and/or healthcare facilities in the region will be impacted in some way.


☐ Entire Region The vast majority of the region is affected by this incident. All hospitals and/or healthcare facilities in the region, and others in adjacent/nearby regions, will be impacted in some way.

Event Impacts

Threat / Hazard: Electric Power Failure

Health System Preparedness Core Capability: Human Impact:

Mortality Could be affected (high heat or cold days)

EMS Operations EMS calls might increase

ED Visits ED visits may increase

Primary Care Office Visits Primary care visits may decrease

Trauma Center Injuries Could be affected Traffic lights out Accidents

Mental Health Impact There could be an increase in mental health referrals

Outpatient Services May be affected, offices may need to close

Hospital (House) Bed Availability Could be affected if outpatient or primary care office visits are affected

ED Bed Census Could be affected based on environmental issues

Community Impact: Water supply that is dependent on well water

Would be affectedPublic Utilities

Transportation Loss of power for trains or gas for a motor vehicle Business Continuity COOP plans would be needed

Population Displacement Could be affected by this event / incident

Environmental Considerations Could be affected by this event / incident

Public Health Services Impact: Information Sharing There would be an increase in the need for information sharing

among healthcare partners

Mass Care / Sheltering Red Cross may be activated

Mass Prophylaxis/ Medical Countermeasure Management

N/A

Fatality Management Moderate Impact could be seen


This population could be affectedVision Disability



Pediatrics Would be affected

Geriatrics Would be affected

Scope of Impact





☒ Multiple Isolated Locations





Event Impacts

Threat / Hazard: Hurricanes

Health System Preparedness, Health System Recovery and Volunteer Management Core Capability: Human Impact:

Mortality Potential for HIGH impact

EMS Operations Increase in call volume due to healthcare facility evacuations Issue with gaining access due to impassible roads and downed wires


Increased staffing needed

Primary Care Office Visits Closed

Trauma Center Injuries Slight increase 6-12 post-storm

Mental Health Impact Might increase with this event

Outpatient Services This service would be discontinued

Hospital (House) Bed Availability Decrease due to a loss of ability to discharge patients during the storm and possible evacuations

ED Bed Census During Storm ED Bed Census would decrease

After Storm ED Bed Census would increase

Community Impact: Water supply Could be disrupted or contaminated

Public Utilities Increased possibility of power outages

Transportation May be shut down


Cancelling of elective surgeriesUnable to service ESRD patients Home Healthcare Services availability could decrease

Population Displacement This could increase with this event

Environmental Considerations Contaminated water Untreated sewageRecovery issues related to mold, water in buildings, other damage to structures, etc.

Public Health Services Impact: Information Sharing Increased need for information sharing among healthcare

partners

Mass Care / Sheltering This event would increase the need for Mass Care and Shelter Operations


N/A

Fatality Management This event could increase Fatality Management


This event could place this population at greater risk

Vision Disability



Pediatrics This event would place this population at greater risk

Geriatrics This event would place this population at greater risk

Homeless This event could place this population at greater risk Could increase the number of new homeless

Scope of Impact










Event Impacts

Threat / Hazard: Severe Winter Storm - (heavy snow, blizzards, ice storms)

Health System Preparedness, Health System Recovery, Medical Surge Core Capability: Human Impact:




Increase in staffing needed

Primary Care Office Visits Primary Care Office may close


Mental Health Impact Could be affected

Outpatient Services Could be affected


ED Bed Census Increase 6-12 hours post-storm

Community Impact: Water Supply During extended freeze, pipes might freeze

Public Utilities Wind / ice damage on above ground wires / lines

Transportation Unable to travel due to road closures


Cancelling of elective surgeries Unable to service ESRD patients Home Healthcare Services availability could decrease

Population Displacement Possible minimal impact

Environmental Considerations Hazards

Snow removal Slip / Trip / fall injuries increase Low temperature injuries increase

Public Health Services Impact: Information Sharing Increased need for sharing among healthcare partners

Mass Care / Sheltering Staff / Patients

This event would increase the need for mass care and sheltering


N/A

Fatality Management Normal effect


Normal risk needs Medications Power (any homecare machines) / heat Dr. Visits

Vision Disability



Pediatrics This event would place this population at greater risk

Geriatrics This event would place this population at greater risk

Homeless Low Temperature injuries could affect this population

Scope of Impact







☒ Half of Region Half of the region is affected by this incident. At least six hospitals and/or healthcare facilities in the region will be impacted in some way.



Event Impacts

Threat / Hazard: Pandemic Influenza

Health System Preparedness, Volunteer Management Core Capability: Human Impact: Increased Public Health Surveillance

Mortality Excess daily deaths over the normal daily death rate for the region

EMS Operations Excessive daily EMS transports over normal daily rate to the facility

ED Visits Excessive daily Emergency Department visits over normal daily rate for the facilities in the region

Primary Care Office Visits Excessive daily medical office visits to primary care providers over normal daily rate for the region

Trauma Center Injuries Fewer staff available for surgeries

Mental Health Impact Excessive number of people developing psychological and behavioral changes during the incident.

Outpatient Services Loss of primary care provider services due to the incident (use of the area for surge locations / treatment areas)

Hospital (House) Bed Availability There will be a need to free up beds with early discharge

ED Bed Census Determine need for forward triage and on site alternate care sites

Community Impact: Water supply Would not be affected by this hazard

Public Utilities Would be affected by this hazard

Transportation Would be affected by this hazard

Business Continuity Healthcare Resilience

Schools closed –40% loss of staff predicted Rationing of supplies

Population Displacement • Food service issues • Public safety (fire , EMS, PD)

This event would cause possible population displacement

Environmental Considerations Social Distancing

This event would cause an increase in environmental concerns

Public Health Services Impact: Information Sharing CDC / NYC / NYS

This event could affect media issues Myth / rumor control

Mass Care / Sheltering This event will cause an increased need


Prevention Treatment

This event will cause an increased need

Fatality Management Activation of surge plans – county / state assistance

At Risk Populations at risk populations are at greater risk for negative issues from certain disasters than the general population.Hearing Disability

No increase in effect for these populations

____________________________________________________This population could be affected by this hazard more than the general population and require additional resources

Vision Disability



Pediatrics This population would be affected by this hazard

Geriatrics

Incardinated population This population would be affected by this hazard more than the general population and require additional resources

institutionalized This population would be affected by this hazard more than the general population and require additional resources

Dorm Students This population could be affected by this hazard more than the general population and require additional resources

Homeless This population would be affected by this hazard more than the general population and require additional resources

Scope of Impact





☐ Multiple Isolated Several areas (but not more than one-quarter) of the region are affected

Locations by this incident. At least four hospitals and/or healthcare facilities in the region will be impacted in some way.



☒ Entire Region The clear majority of the region is affected by this incident. All hospitals and/or healthcare facilities in the region, and others in adjacent/nearby regions, will be impacted in some way.

Event Impacts

Threat / Hazard: Nor’easter





Increase in staffing issues

Primary Care Office Visits Could be affected by this event / incident


Mental Health Impact Expect a low impact

Outpatient Services There would be a decrease in service due the closing of services


ED Bed Census Increase 6-12 hours post-storm

Community Impact: Water supply Could be disrupted or contaminated

Public Utilities Wind damage on above ground wires

Transportation Might be affected by this event / incident


Cancelling of elective surgeriesUnable to service ESRD patients Home Healthcare Services availability could decrease

Population Displacement This could increase with this event Environmental Considerations Contaminated water

Untreated sewage

Recovery issues due to mold, and other structural impactsPublic Health Services Impact: Information Sharing Increased need for information sharing among healthcare

partners



There could be a need for this

Fatality Management Normal effect



Vision Disability



Pediatrics This population would be affected by this hazard

Geriatrics This population would be affected by this hazard

Scope of Impact





☒ Multiple Isolated Locations





Event Impacts

Threat / Hazard: Emerging Infectious Disease An unexpected novel disease that is highly infectious NEW FOR 2016 with increased mortality


Mortality There could be an increase in this area

EMS Operations EMS volume would increase; system could become overwhelmed

ED Visits There would be an increase in this area

Primary Care Office Visits There would be an increase in this area

Trauma Center Injuries Resources and staff reductions – 40% decrease in staff expected

Mental Health Impact There would be an increase in this area

Outpatient Services There would be an increase in this area

Hospital (House) Bed Availability Would be affected

ED Bed Census Would be affected

Community Impact: Water supply

The impact for these would be based on estimated staff reductions

Public Utilities

Transportation

Business Continuity Community / Facility

ResilienceThis would be affected by the event

Population Displacement This would be affected by the event

Environmental Considerations i.e. medical waste

This would be affected by the event


among partner agencies

Mass Care / Sheltering This would be affected by the event based on cohorting of people


There would be an increased need of Mass Prophylaxis

Fatality Management There could be an increased need of fatality management


Would be affected by the event requires good information sharing

Education on cross-contamination

Depends on the disaster / event

Vision Disability



Pediatrics

Geriatrics Cohorting

Scope of Impact










Event Impacts

Threat / Hazard: Large Area Flood - standing water (pooling water), flooding from ground water – other coastal flooding that does not receded New For 2016

Health System Recovery Core Capability: Human Impact:

Mortality There event would be a minimal effect on mortality

EMS Operations This event could overwhelm the EMS with increased calls for service

ED Visits There could be an increase in ED visits

Primary Care Office Visits There would be a minimal effect

Trauma Center Injuries There could be an increase in ED visits

Mental Health Impact There may be an increase after the incident during recovery

Outpatient Services There would be a minimal effect on outpatient services

Hospital (House) Bed Availability Discharges to home affected

ED Bed Census There could be an increased need for bed availability

Community Impact: Water supply Possible effect after the floods recede because of contaminants

and raw sewage

Public Utilities This could be affected by the event

Transportation This event could disrupt transportation in some areas

Business Continuity • Community / Facility Resilience

Question to be considered – did the HCF shut down due to the flooding

Population Displacement This event could cause population displacement in the flood areas

Environmental Considerations Possible potable water contamination


among partner agencies



There would be an increased need of Mass Prophylaxis

Fatality Management There would be an increased need of fatality management if HCFs are affected



Vision Disability



Pediatrics

This at-risk population would be affectedGeriatrics

Scope of Impact



☒ Single Location, Large Area







Event Impacts

Threat / Hazard: Heat Wave

Medical Surge Core Capability: Human Impact:

Mortality This event could increase mortality rates

EMS Operations This event could overwhelm the EMS system due increased calls for service

ED Visits This event could cause an increase in ED visits casing a medical surge

Primary Care Office Visits This event could cause an increase

Trauma Center Injuries This event should not cause an increase in trauma injuries

Mental Health Impact This could be affected by the event

Outpatient Services This event should not cause an increase or decrease in outpatient services

Hospital (House) Bed Availability This could be affected by the event and increase if discharges are affected and due to impacted status of other HCFs

ED Bed Census This could increase based on the event

Community Impact: Water supply This event could cause a decrease in water volume / pressure

Public Utilities This event could cause an additional draw of the public utilities and cause rolling brownouts

Transportation

Business Continuity Community / Facility

Resilience

The event could cause an increase in volume at HCFs

Population Displacement This could increase due to the event

Environmental Considerations This could be affected by the event in many areas


Mass Care / Sheltering This could be affected – opening of cooling center

Mass Prophylaxis / MCM N/A

Fatality Management There could be an increased need for fatality management


These areas would be affect by the event

Vision Disability



Pediatrics

These populations may be greatly affected Geriatrics

Scope of Impact










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